Provider Demographics
NPI:1558633610
Name:DEAN, PRISCILLA E (LPC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:E
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6850
Mailing Address - Country:US
Mailing Address - Phone:630-588-1201
Mailing Address - Fax:
Practice Address - Street 1:1616 E ROOSEVELT RD
Practice Address - Street 2:SUITE 8
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6850
Practice Address - Country:US
Practice Address - Phone:630-588-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional